Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #393 out of 500 highest-risk providers analyzed. This is a statistical prediction, not a determination of fraud.
ML model prediction — not an accusation of fraud
This provider's $487.4K in total Medicare payments ranks in the 91th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 124% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office visit, established patient, low complexity | 1.5K | $107.5K | $73.29 | 2.45x |
| 99214 | Office visit, established patient, moderate complexity | 1.3K | $96.8K | $73.31 | 1.99x |
| 99215 | Office visit, established patient, high complexity | 1.2K | $86.0K | $73.33 | 1.73x |
| 99232 | Subsequent hospital care, moderate complexity | 1.0K | $75.3K | $73.28 | 2.09x |
| 99233 | Subsequent hospital care, high complexity | 880 | $64.5K | $73.31 | 2.24x |
| 93000 | Electrocardiogram, complete | 733 | $53.8K | $73.34 | 2.34x |
| 71046 | Chest X-ray, 2 views | 587 | $43.0K | $73.27 | 1.86x |
| 80053 | Comprehensive metabolic panel | 440 | $32.3K | $73.31 | 2.06x |
| 85025 | Complete blood count with differential | 293 | $21.5K | $73.39 | 2.39x |
| 36415 | Venipuncture for blood draw | 147 | $10.8K | $73.14 | 1.90x |
This provider submits charges 2.13 times higher than what Medicare actually pays.
A markup ratio of 2.13x means for every $100 Medicare pays, this provider initially charges $213. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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